Emergency Department Patients Are More Likely to Have Chronic Diseases

Chronic diseases are common among emergency department patients, particularly among seniors and those ages 45 to 64, according to a National Health Statistics Report.

“Monitoring ED visits made by adults at highest risk of severe COVID-19-related illness is important for understanding the health burden of COVID-19 and for planning prevention strategies,” the researchers explained. “Ongoing monitoring of the presence of these underlying chronic conditions at ED visits will continue to inform COVID-19 response efforts.”

The researchers relied on The National Hospital Ambulatory Medical Care Survey (NHAMCS) to assess the relationship between the presence of chronic disease and emergency department use. The study covered 2017 to 2019, before the coronavirus pandemic took hold in the US.

The data showed that 107.3 million emergency department visits occurred each year during the study’s timeframe.

Of the 107.3 million individuals with chronic diseases who went to the emergency department each year, 59.5 percent were for adults with at least one chronic disease. The study looked at 14 conditions that are known to accompany severe coronavirus symptoms, including depression, HIV, substance use disorders, chronic kidney disease, chancer, dementia or Alzheimer’s disease and more.

A little less than a quarter of the adults had one chronic disease. Another 16.5 percent of adults had two chronic conditions and nearly one-fifth of adults (18.1 percent) had three or more conditions.

Most adults who had three or more chronic conditions and who went to the emergency department were ages 45 to 64.

Older adults who went to the emergency department often had chronic conditions. The share of individuals with only one chronic condition also dropped as they grew older.

The number of seniors (ages 75 and older) who went to the emergency room and had no chronic conditions was only 3.3 percent. Nineteen percent of individuals who went to the emergency department and who had two chronic conditions were individuals ages 75 and older. And seniors made up more than a quarter of emergency department visits for individuals with three or more chronic diseases (26.5 percent).

The share of Medicare beneficiaries who had multiple chronic conditions and went to the emergency department also attested to the trend of senior emergency department patients having multiple chronic conditions. Although not all Medicare beneficiaries are 65 or older, the majority of Medicare beneficiaries are seniors.

Among all of the individuals who visited the emergency department and who had two chronic conditions, four out of ten were covered under Medicare (40.8 percent). Among those with three or more chronic diseases, nearly six out of ten were covered by Medicare (57.6 percent).

Additionally, a third of individuals with emergency department visits and no chronic diseases were covered under private insurance and another third were covered under Medicaid.

Emergency department prescriptions were also tied to chronic disease. A little over 28 percent of patients who were prescribed five or more medications had three or more chronic conditions.

Individuals with chronic diseases were more likely to be admitted to the hospital. Almost two out of ten individuals with two chronic conditions and three out of ten individuals with three chronic conditions were admitted to the hospital from the emergency department.

The top five most common chronic conditions among patients in the emergency department were hypertension (33.8 percent), diabetes (16.0 percent), depression (12.7 percent), heart disease (11.4 percent), and substance use disorder (10.5 percent). A couple of these are also among the most expensive chronic conditions in the US.

Hypertension and diabetes were most commonly co-occurring for adults under the age of 75. Heart disease and hypertension were most commonly co-occurring for patients 75 years of age and older. Certain pairings of chronic conditions can increase costs for treatment.

These results have implications for coronavirus-related healthcare spending. Experts had already determined that patients with chronic diseases were more prone to developing severe coronavirus symptoms. Previous research showed that, among the Medicare population that was hospitalized for COVID-19, eight out of ten beneficiaries had hypertension and over half had chronic kidney disease.

This study’s findings may offer a baseline from which healthcare leaders can form expectations about the prevalence of diseases that can lead to more severe coronavirus symptoms.